with the term medicine as the name of a science. Popularly the term physic means a drug, and especially a purgative drug. These facts are cited to show that, outside of the medical profession, the practice of medicine and medicinal therapeutics are regarded as about one and the same thing.

It is a general impression with those who are not of the medical profession that eminence in this profession is based chiefly on superior attainments in medicinal therapeutics. The fact that one may be an accomplished anatomist, an erudite physiologist, a profound pathologist, and a distinguished diagnostician, irrespective of extraordinary knowledge or skill in the medicinal treatment of diseases, is not appreciated. In this point of view, the science of medicine in the popular mind is identified with the employment of drugs.

It is needless to argue before this audience that a physician is not to be regarded purely as a prescriber of drugs; that the terms medicine and physic may have a broader and higher sense than that which limits their application to the materia medica; and that true eminence in the profession is by no means derived exclusively from medicinal therapeutics. I need not say that to withhold drugs in the treatment of cases of disease is as inportant an exercise of professional judgment as to employ them. In view of the prevailing popular errors just referred to, it is often more politic for the medical practitioner to employ than to withhold drugs. By withholding drugs, he may not only disappoint the expectations of his patients or of their friends, but he incurs a risk of having his disuse of drugs attributed to want either of knowledge of the disease or of interest in the case, and thereby to a withdrawal of confidence. The prevalence of these errors places the practitioner in a false position. Nothing is easier than to prescribe drugs. On the other hand, to refrain from their use may require, in addition to knowledge and judgment, not a little firmness and independence. An ignorant or a weak practitioner, therefore, may be tempted to pursue a medicinal treatment in opposition to his judgment or in order to cover up his lack of knowledge. Herein the popular errors may interfere with the usefulness of medical practice. More

over, these errors do injustice to the science of medicine as well as to the medical profession.

The time will come when the physician will not be regarded as merely a therapeutist, but as a medical counselor, whose functions embrace the preservation of health and the prevention, not less than the treatment, of diseases. Patients will then congratulate themselves, and be congratulated by their friends, whenever it is decided by the physician that potential drugs are not called for; but, it should be added, drugs will then never be withheld if, in the judgment of the physician, they are indicated. This reformation, if I may so call it, is to be brought about by a change in popular ideas respecting the practice of medicine. Let the public understand that drugs are not to be employed as a matter of course, whenever a physician is consulted or is in attendance. Let placebos be seldom, if ever, required for a moral effect. Let it be understood that, as modern clinical studies have demonstrated, many diseases end in recovery, from intrinsic tendency and self-limitation. Let it be popularly known that most medicinal agents are curative, not directly, but indirectly, by the removal of obstacles in the way of recovery; that nature is always the efficient curative agent, and, therefore, that the physician is nature's servant, not her master. Let the value of medical science, in the palliation of suffering and the promotion of the toleration of diseases which do not admit of recovery, be fairly appreciated. When these desirable objects are accomplished, the medical profession will hold a position in public estimation higher, even, than it now holds; a more elevated standard of medical education will become a necessity; and the usefulness of the profession will be increased. Moreover, this reformation will prove the most efficient of the means for the protection of the public against irregular and illegitimate systems of medical practice, and, as may be added, against the unworthiness of those who profess to be regular, or legitimate practitioners. The most popular of the systems opposed to legitimate medicine and the regular profession at the present time is based on the assumption that diseases are controlled by drugs, according little or nothing to a natural tend

ency to recovery. Correct popular ideas of medicinal and nonmedicinal therapeutics are incompatible with confidence in this or in any system of practice, which assumes that recovery from diseases is always due wholly to medicinal agencies. Let correct ideas prevail, and there will be fewer instances than now, within the ranks of the profession, of unworthy means to secure a local reputation and to enhance the sense of obligation for professional services. In other and plainer language, there will be less of quackery within, as well as without, the medical profession.

As preliminary to the reformation in popular ideas to which I have alluded, there must be more unanimity than now exists. in the medical profession respecting medicinal therapeutics. There is considerable diversity among physicians with respect to their estimation of the importance of drugs, and a corresponding diversity in practice. There are practitioners who, in this regard, exemplify opposite extremes. Some practitioners have an excessive and unwarrantable faith in drugs; others are excessively and unwarrantably skeptical. Any physician who has a considerable number of acquaintances among his fellowpractitioners will readily recognize examples of each of these extremes. Pharmacomania is a form of mental aberration affecting alike certain physicians and patients. The latter have a morbid craving for, and the former an abnormal propensity to prescribe, drugs. If it so happen that a pharmacomaniacal patient be under the care of a practitioner to whom that name applies, there may be mutual satisfaction; but, if not so mated, there is likely to be dissatisfaction on both sides.

The pharmacomaniacal practitioner never tires in the use of remedies. He has a distinct drug for every symptom, and remedies are multiplied in proportion as new symptoms appear. One may know that a practitioner belongs to this extreme class, by a glance at the array of phials, cups, and glasses at the bedside of the patient. The prescriptions, which accumulate daily, contain a multiplicity of ingredients, each, perhaps, designed for a particular object; or, to borrow a well-known comparison, they are like a heavily loaded shotgun, intended to do execution, although discharged without much regard to aim. His patients

after recovery have a large collection of souvenirs consisting of the daily surplus of prescribed remedies. To the apothecary he is a "joy for ever." A catalogue of the medicaments presented by the apothecary as a memento shows that Molière did not exaggerate in the enumeration with which he opens his play, "Le malade imaginaire." The pharmacomaniacal practitioner is never discouraged in the use of new remedies. He reads medical treatises and journals with special reference to these, and he loses no time in giving his patients the benefit of all in succession. As one new remedy after another becomes obsolete in consequence of having been found useless or injurious, he relinquishes it only to supply its place with one still more recent, always adopting the latest with as much avidity as he had accepted the remedies which he has discarded.

The practitioners who exemplify the opposite extreme, the skeptic, or, as may be said, the disbeliever, need not be delineated, inasmuch as the picture would be precisely the reverse of the one just presented.

Truth, of course, lies somewhere between these extremes; and between the truth and the extremes are different gradations. Here, as in other instances, "in medio tutissimus ibis" is the conservative maxim. The practitioner who holds a just medium between the two extremes has sufficient confidence in medicinal agents, but, recognizing that, in proportion to their potency they do either good or harm, he must be satisfied that they are clearly indicated before he employs them. He will not prescribe potential drugs at a venture, but only for a clearly defined purpose. He shoots after having taken deliberate aim; and he shoots with the rifle instead of with the shotgun. He requires competent testimony, based on trustworthy experience, before subjecting patients to the trial of new remedies. Fully alive to the progress of knowledge in medicinal therapeutics, he holds fast to what is actually known, and he adopts what is new, on satisfactory evidence afforded by his own experience added to that of others. He may make original observations in order to enlarge the boundaries of therapeutical knowledge, but his observations are made with due precautions, not overlooking his responsibil

ity for the welfare of his patients. His observations have for their sole object the discovery of truth for a beneficent end. He is conservative, but his conservatism is not fogyism. He cultivates and practices medicine as a science, but he never forgets that medicine is a science of which the pervading principle is humanity.

A fact not to be lost sight of is that the only reliable basis of therapeutical knowledge is clinical experience. It is not sufficient to conjecture from the properties of drugs as to what they ought, reasoning a priori, to effect. It may take a long time for clinical experience to overthrow fallacious conclusions reached by such a method of reasoning. The results of experiments on lower animals must be accepted with caution. It is true that clinical experience is beset with difficulties which exemplify the Hippocratic axiom, "experientia fallax." The "post hoc, propter hoc" errors are often enough alluded to; nevertheless, they abound in the practice of medicine. How often can we be assured, when notable improvement has attended a certain measure of treatment, that the same improvement would not have followed the employment of a different measure, or would have occurred if nothing had been done therapeutically! Great as are the difficulties in the way of determining the precise therapeutical value of drugs, clinical experience is the only tribunal from which there is no appeal.

It is a striking fact that our knowledge of those medicinal agents which are acknowledged to have the most special therapeutical value, until lately rested wholly on an empirical basis; that is, their modus operandi was entirely unknown. This is true of cinchona and other antiperiodic drugs, mercury and iodine in syphilis, and chalybeates, prior to our present knowledge of anæmia. At the present time, it can be said that the therapeutical value of cinchona, mercury, and iodine probably depends on their efficacy as parasiticides. This explanation came long after the discovery of the therapeutical value of these drugs. It is not easy to name drugs of equal therapeutical value, to the knowledge of which a priori reasoning led the way. Yet, although clinical experience is the only basis of our actual knowledge, analogi